Sample Utilization Review Nurse Resume

Posted in Nurse Resume Samples

Sabrina Thomas
1637 Lady Bug Drive
Colorado Springs, CO 80903
(222)-570-2644
[email]

Career Objective To obtain a position as an Utilization Review Nurse where my special skills can be used to their fullest potential to help improve the hospital.

Summary of Qualifications:

  • Remarkable experience in geriatric nursing, renal, cardiac and endocrinology
  • Exceptional knowledge of utilization review, case management, and disease management
  • Solid understanding of state and federal regulatory requirements affecting care coordination services, specifically CMS, Medicaid and HIPAA
  • Proficient in Microsoft Word, Excel and utilization review modules in information systems
  • Ability to work as a team member to strategize future program enhancements
  • Ability to provide commitment to excellence in nursing and to communicate well with frail elderly and providers

Work Experience:

Utilization Review Nurse, August 2005 – Present
Coventry Health Care, Colorado Springs, CO

  • Managed assigned workload within established performance standards.
  • Participated in discharge planning process with hospital and inpatient facility staff, ensuring adequate and appropriate disposition and post discharge plans.
  • Coordinated smooth transition and follow-ups from one level of care and service to another.
  • Maintained all required documentation in the information systems.
  • Participated in case conferences, clinical in-services, and other educational opportunities.
  • Recorded information in Claims Management system and communicated with the Claims Adjuster to process valid medical treatment requests for authorization per policy.

Utilization Review Nurse, May 2000 – July 2005
XLHealth, Colorado Springs, CO

  • Determined medical necessity of the requested treatment.
  • Communicated with requesting providers, service providers, claims adjusters and claimants via telephone and fax to request additional information.
  • Coordinated care and provided verbal authorization for medical treatment per policy.
  • Assisted in medical training for claims adjusters.
  • Maintained ongoing compliance with federal, state or Federal laws, URAC standards.
  • Ensured cost effective and quality patient care by appropriate utilization of medical resources.

Education

B.S in Health Services Management, Florida State University, Tallahassee, FL

Example #2

Kelsey Lee
602 S Main St
Oak Park, CA 91301
(555)-339-2070
[email protected]

Objective Looking for a challenging role as an Utilization Review Nurse in the field of the nursing and caring where my skills and knowledge can be utilized effectively.

Career Profile:

  • Immense ability to work under stress, both with and without supervision.
  • Strong ability to quickly analyze and interpret data.
  • Extensive working experience in the field of case management and utilization review.
  • Sound knowledge in conducting and reviewing medical record for medical necessity.
  • Wide knowledge of health care service delivery schemes and third party reimbursement.

Nursing Experience:

Utilization Review Nurse, 2004 to till date
UCLA Medical Center, Los Angeles, CA

  • Maintained records of the utilization review department.
  • Monitored and reported on patient activities, mental status and progress to the insurance company.
  • Performed utilization review in accordance with all state mandated regulations.
  • Reviewed patient’s records and evaluated patient’s progress.
  • Aided and coordinated telephonic and on-site inpatient and outpatient care through precertification, concurrent review and discharge planning.

Academic Background

Health Care Quality & Management Board Certification, 2004
Yale School of Nursing, New Haven, CT

B.S in Nursing, 2003
University of Washington, Seattle, WA



Create your own professional looking resume for free using our resume builder!